Treatment Of Stage III Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Publication Date: November 1, 2013
Last Updated: March 14, 2022
Recommendations
Infiltrative Stage III (N2/N3) Disease
In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, radiotherapy alone is not recommended. (1, A)
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In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, combination platinum-based chemotherapy and radiotherapy (60-66 Gy) are recommended. (1, A)
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In patients with infiltrative stage III (N2,3) NSCLC, performance status 0-1, and minimal weight loss being considered for curative-intent treatment, concurrent chemoradiotherapy is recommended over sequential chemoradiotherapy.
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In patients with infiltrative stage III (N2,3) NSCLC with a complete response after treatment with concurrent chemoradiotherapy, it is suggested that PCI should not be given (outside of a clinical trial). (2, C)
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In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, treatment with neoadjuvant (induction) chemotherapy or chemoradiotherapy followed by surgery is not recommended. (1, C)
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In patients with infiltrative stage III (N2,3) NSCLC and performance status 2 or those with substantial weight loss (>10%), concurrent chemo radiotherapy is suggested but with careful consideration of the potential risks and benefits. (2, C)
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In patients with infiltrative stage III (N2,3) NSCLC, performance status 0-1, and minimal weight loss being considered for curative-intent reatment, a platinum-based doublet chemotherapy is suggested. (2, C)
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In patients with symptomatic infiltrative stage III (N2,3) NSCLC and either performance status 3-4, comorbidities, or disease too extensive to treat with curative intent, palliative radiotherapy is recommended. The fractionation pattern should be chosen based on the physician’s judgment and patient’s needs. (1, C)
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Discrete Mediastinal Node Involvement
In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), it is recommended that the treatment plan should be made with the input from a multidisciplinary team. (1, C)
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In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), either defi nitive chemoradiation therapy or induction therapy followed by surgery is recommended over either surgery or radiation alone. (1, A)
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In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), primary surgical resection followed by adjuvant therapy is not recommended (except as part of a clinical trial). (1, C)
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Occult N2 Involvement Despite Thorough Preoperative Staging (Stage IIIA)
In patients with NSCLC undergoing surgical resection, systematic mediastinal lymph node sampling or complete MLND is recommended. (1, B)
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In patients with NSCLC who have incidental (occult) N2 disease (IIIA) found at surgical resection despite thorough preoperative staging and in whom complete resection of the lymph nodes and primary tumor is technically possible, completion of the planned lung resection and mediastinal lymphadenectomy is suggested. (2, C)
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In patients with resected NSCLC (R0) who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging and who have good performance status, adjuvant platinum-based chemotherapy is recommended. (1, A)
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In patients with R0 resected NSCLC who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging, sequential adjuvant radiotherapy is suggested when concern for a local recurrence is high. (2, C)
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In patients with NSCLC who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging and were incompletely resected (R1,2), combined postoperative concurrent chemotherapy and radiotherapy is suggested. (2, C)
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Title
Treatment Of Stage III Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Authoring Organization
American College of Chest Physicians
Publication Month/Year
November 1, 2013
Last Updated Month/Year
June 26, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
Stage III non-small cell lung cancer (NSCLC) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky nodal disease. This review updates the published clinical trials since the last American College of Chest Physicians guidelines to make treatment recommendations for this controversial subset of patients.
Target Patient Population
Patients with Stage III non-small cell lung cancer
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospice, Hospital, Long term care, Operating and recovery room, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D002289 - Carcinoma, Non-Small-Cell Lung, D008175 - Lung Neoplasms, D016371 - Cranial Irradiation
Keywords
lung cancer, non-small cell lung cancer, radiation therapy, Non Small Cell Lung Cancer, non_small_cell_lung_cancer, Adjuvant Radiation Therapy